CMS proposed outpatient payment rule for 2022: 7 things to know

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CMS unveiled on July 19 its Outpatient Prospective Payment System proposed rule for 2022, which boosts penalties for hospitals not complying with price transparency and halts the elimination of the inpatient-only list.

Seven takeaways from the proposal: 

1. Payment update. CMS proposed increasing outpatient prospective payment system  rates by 2.3 percent in 2022 over 2021 rates. Based on this update, CMS estimates that total payments to outpatient prospective payment system providers would be $82.7 billion next year, up about $10.8 billion from 2021. 

2. Price transparency violation penalty. To boost compliance, CMS proposed increasing the minimum fine for price transparency violations to up to $2 million per year. In particular, hospitals with more than 30 beds in violation of the rule would pay $10 per day for each bed, up to $5,500 per day. Hospitals with 30 beds or fewer would continue to pay up to $300 per day. This would make the annual penalty at least $109,500, or as high as $2 million a year for large hospitals that fail to make prices public. 

3. Ban on coding to hide prices. The proposed rule would also clamp down on the use of special coding that prevents search engines from displaying pricing in search results. 

4. 340B program. CMS proposed continuing its lower payment rate for 340B drugs. CMS proposed paying hospitals 22.5 percent less than the average sales price for 340B-acquired drugs. 

5. Halt elimination of inpatient-only list. Last year, CMS proposed phasing out the inpatient-only list over three years, beginning with the removal of 298 services. Now it wants to reverse course. CMS also is seeking to add back the 298 services removed from the inpatient-only list this year to the inpatient-only list in 2022.

6. Changes to ASC-covered procedures list. CMS proposed eliminating 258 of the 267 procedures it added to the covered procedures list last year. 

7. Comment period. CMS is accepting comments on the proposed rule until Sept. 17.

Access the full rule here

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